Depression and antidepressant use are associated with prolonged recovery and increased opioid dependence following ulnar nerve transposition.

Abstract

Depression is common among patients with cubital tunnel syndrome and may adversely influence surgical recovery. This study evaluates the impact of depression and antidepressant use on postoperative complications following ulnar nerve transposition (UNT). A retrospective cohort study was performed using the TriNetX Research Network. Adults undergoing primary UNT between 2005 and 2025 were identified and stratified by depression status. Three 1:1 propensity-matched analyses were performed to evaluate the impact of (1) depression status, (2) antidepressant use among depressed patients, and (3) specific antidepressant subclasses. Matching controlled for demographics and comorbidities. Outcomes included 90-day medical and postoperative complications and 1 year pain-related outcomes and opioid dependence. After matching, 11,821 patients were included in each cohort. Depression was associated with significantly higher 90-day medical morbidity, including infection (RR 1.39, P = 0.0008), acute postoperative pain (RR 1.28, P < 0.0001), emergency department utilization (RR 1.37, P < 0.0001), and increased need for PT evaluation (RR 1.21, P < 0.0001) and orthopedic aftercare (RR 1.11, P = 0.001). At 1 year, depressed patients demonstrated higher rates of persistent elbow pain (RR 1.16, P < 0.0001) and nearly double the risk of opioid dependence or abuse (RR 1.88, P < 0.0001). Among patients with depression, preoperative antidepressant use was associated with higher 1-year opioid dependence (RR 1.66, P = 0.007) and persistent pain (RR 1.21, P = 0.001). SSRI use specifically was linked to increased long-term pain (RR 1.17, P = 0.001) and opioid dependence (RR 1.31, P = 0.023). TCA use was associated with higher 90 day ED visits (RR 1.20, P = 0.022), while atypical antidepressants were associated with increased acute postoperative pain (RR 1.42, P = 0.004). Depression was associated with adverse postoperative outcomes after UNT. Antidepressant use, particularly SSRIs, was associated with higher long-term pain and opioid-related risk; however, these associations may reflect underlying depression severity rather than a direct pharmacologic effect.